'Do not resuscitate' notes at nursing home queried

HIQA carried out inspections at Mullross Nursing Home in December and earlier this month

A new inspection report into the private Mullross Nursing Home in Kilclare, Co Leitrim, has revealed that "do not resuscitate" directions were in some residents' files.

The report says there was no evidence available that the home had ensured this had been discussed with the residents, or their relatives, or the multidisciplinary team.

The HIQA inspections in December and earlier this month found that there was no evidence that any communication had occurred with regard to resuscitation orders to ensure the residents had been involved in the decision.

It was confirmed today that the home, which was taken over by the HSE in early January, has closed and all residents have been moved out.

Hopes locally that the home could be kept open under new management have faded.

Today, the Health Information and Quality Authority published the final inspection report, which led to the HSE taking control of the facility, which could cater for 30 residents and employed 32 staff.

HIQA says the system in place at Mullross increased the risk of medical errors occurring.

Some medicines that were not suitable for crushing were crushed by staff and no maximum dose was identified for some pain killers, some of which were controlled drugs.

No temperature gauge was available in the medication fridge to control the temperature of certain drugs.

The report cites persistent failings of the Health Act 2007 and found:

- There had been no person in charge of the home from September 2011 until May 2012

- Poor wound management, nutritional assessment and pain management

-A photograph of wounds could not be taken to monitor care due to a dead battery in the camera.

- A resident had a serious pressure sore that was not receiving suitable care

- Many residents had not been weighed recently even though they had been losing weight

- An incident of bruising to a resident was recorded in the care file but not documented in an incident report and was not investigated

- A failure to monitor a resident after they had an epileptic seizure

- A resident who had deteriorated from 13 December to 18 December 2013 without an apparent medical review

- It found that the person in charge had resigned from her post in late December, the third person in charge since the home had been registered.

During the inspection, the provider told HIQA that seven residents were medically reviewed each Monday but there was no documentation in the medical file to support this.

The Health Service Executive took control of the home in Leitrim on 4 January last.

Following the concerns raised by HIQA, a meeting was held with the registered provider of the home, who agreed to the authority's decision to cancel his registration.

The HSE made alternative arrangements for the management of the home, but it has now closed.

Mullross Nursing Home wrote to residents at the end of December saying it was to close and alternative accommodation would have to be found.

The home had operated since 1987.

At the start of this month, Stephen Buckley, the registered provider, said that the home would not be able to meet the requirements of the 2009 Health Act by January 2014 and had to give notice to residents and staff.

He said that the physical structure and room sizes were issues and the building would not be compliant with regulations.

The home was leased from owner Patricia Foley.

Ms Foley had insisted that the physical structure issues could be dealt with by 2014 and she had hoped to be possibly in a position to take it over.

A HIQA inspection report on the home in May 2012 found that some actions required since the last inspection had not been implemented.

Among the issues of concern then were the management of medicines, staffing and recruitment, maintenance of records, notification of incidents and the complaints procedure.

A HSE inspection in 2007 found the home was not complying with certain regulations, including the prevention of infection.

The Irish Patients' Association has said it is shocked at the findings of today's report.

Stephen McMahon said it should be made clear who wrote the "Do not resuscitate" orders in some residents' records.

He said the Minister for Health needed to introduce legislation to cover DNR orders to protect vulnerable patients.